Histopathological detection of prostate cancer

Fusion biopsy of the prostate, Munich

Fusion biopsy introduction Munich

Prostate cancer is one of the most common malignant tumor diseases in men and the third most common cause of cancer-related deaths worldwide. In Central Europe alone, over 1 million citizens are diagnosed with prostate cancer each year.

Because at the beginning of prostate cancer there are usually no subjective complaints or pain, we recommend that male patients, in accordance with the international urological guidelines, present themselves to a urologist for prostate cancer screening once a year from the age of 45 if they have a family history of the disease, otherwise from the age of 50.

In addition to the medical history and the physical examination, we routinely perform a urinalysis, a transrectal ultrasound using 3D technology and a PSA determination in the patient's blood serum.

If in particular the PSA value, sonography or the finger-guided palpation reveal abnormalities in the prostate, several tissue samples (biopsies) should be taken from the prostate under anesthesia using online ultrasound monitoring (transrectal 3D sonography) in order to be able to definitively confirm the suspicion of cancer histopathologically.

Only then can cancer therapy take place.

Due to the fact that a potentially curable prostate cancer in the organ-confined growth stage cannot usually be reliably depicted in an ultrasound image, the tissue samples were previously taken randomly from different regions of the prostate using a thin puncture needle.

Fusion biopsy of the prostate in Munich - the most modern, minimally invasive procedure for the reliable histological detection of prostate cancer

In order to be able to selectively remove tissue samples from regions of the prostate suspected of being cancerous under ultrasound control, the first diagnostic step in the case of a tumor-specific prostate finding (elevated PSA serum value/pathological digital palpation finding/pathological PCA3 urine test/pathological sonography finding) is for the radiologist to produce slice images (scans) of the prostate with the aid of a multiparametric MRI (Magnetic Resonance Imaging).

Suspected cancerous areas in the corresponding MRI slice images are marked in color by the radiologist on the basis of defined image processing criteria and sent digitally to the urologist for the planned biopsy.

During the minimally invasive procedure, the MRI slice images are fused online, i.e. in the operating room, with the sonographic slice images shortly before the actual tissue removal from the prostate, i.e. projected on top of each other.

If desired, the urologist receives a two or three-dimensional sonographic image of the prostate, in which the tumor-specific areas in the prostate can also be visualized in the ultrasound image by fusion with the corresponding MRI image.

Only timely histopathological detection of prostate cancer allows an excellent minimally invasive therapy and enables a very high chance of cure.

Alternative diagnostic methods

Random biopsy

In this procedure, tissue samples are taken randomly under digital palpation (finger-guided palpation) or under ultrasound control, i.e. more or less blindly according to the random procedure, usually via a transrectal access route through the rectum from the prostate, in the hope of being able to biopsy the cancer-bearing tissue from an existing cancer area.

Fine needle aspiration Munich

In this procedure, cell clusters are usually aspirated from the prostate under digital palpation (finger-guided palpation) with the aid of a thin aspiration needle via a transrectal access route through the rectum in the hope of being able to cytologically detect tumor cells from an existing cancer area. In this age of biopsy diagnostics, fine needle aspiration is no longer of great clinical significance.

Advantages of the fusion biopsy Munich

This technique allows the urologist to accurately biopsy prostate areas suspected of having cancer and no longer at "random".

The hit rate, i.e. the probability of ultrasound-guided puncturing of areas suspected of having cancer and thus of detecting possible prostate cancer at an early stage, is significantly optimized.

As a result of fewer punctures required to detect prostate cancer, the risk of bleeding and infection within the prostate decreases significantly.

Due to the fact that in the fusion biopsy the prostate is not punctured transrectally, i.e. via the rectum, but transperineally, i.e. via the perineal region, the risk of prostate infection (prostatitis) with risk of urosepsis (life-threatening infection) is significantly reduced compared to the other procedures.

Dr. Meisse is one of the few urologists in Munich who offer the fusion biopsy technique on an outpatient basis.